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The Problem with “Fighting” Cancer

Last time I spoke to you about wording and public health, and the unintentional impact that can have on people. I want to continue on that theme today, and talk about what is perhaps one of the most pervasive, and more controversial language choices that we as as a society have made: the military language we use around cancer. Often, the media (and by extension, society) describe someone with cancer as a “warrior” who “battles” cancer. This language isn’t rare, and has been around since the mid-70s when Susan Sontag wrote her book “Illness as a Metaphor.” Research by Seale (2001) states:

News stories commonly feature sports celebrities with cancer, as well as sporting activities by ordinary people with cancer, designed to generate a sense of (usually successful) personal struggle.

The usually successful component is what results in problems. When we take the metaphor further, we describe it as “conquering cancer” when cancer goes into remission, or describe someone as a “survivor” of cancer. This is then further complicated by how medical professionals and researchers use the term “survivor” as they will have a very specific definition in mind. Some research studies use a five-year survival window following diagnoses, (see the Coleman study referenced below), while the CDC says:

The term cancer survivor refers to a person who has been diagnosed with cancer, from the time of diagnosis throughout his or her life.

This makes all the difference. “Survivorship” for research is a very precise, very defined term. It may not be the same as what an individual defines as being a survivor, and some definitions (such as the one above) may not include anything about quality of life following diagnosis. But even when cancer goes into remission, there’s still a worry that it might come back, and so the term “survivor” may be a misnomer.

On the surface, I get why we use this language. The language is meant to be positive – it’s meant to evoke support. It’s a tough and trying time, and family/friends/colleagues want to provide help in an way they can. So we follow the template set for us by the media and charities to try and help, as words fail us. I should point out though that this language (i.e. “surviving” “battling” “conquering”) isn’t used exclusively for military metaphors; it can also be used in a religious sense, or used in conjunction with sport metaphors, and there are distinct gender differences in how cancer is reported between men and women in the language and imagery we use.

But what’s the other side of that conversation? Someone who “loses” their “fight” against cancer? Someone who has “fallen”? And to take it to the extreme, would they have “made it” if they “fought harder”? Kristen Garrison writes:

How can a woman with metastatic bone lesions read Lance Armstrong’s story of conquering the disease and feel anything but failure? His story may be true, but does not represent the average person, and such narratives, which get so much press attention and bookshelf space, undercut the comparably determined but unsuccessful efforts of people fighting cancer.

There’s a negative side to that language that is coming out, as those diagnosed with cancer speak up. Blogs and social media give people a platform from which to voice their displeasure and connect with others who feel the same way. Heather Cleland (herself diagnosed with cancer) writes:

The language around cancer—of “battles” fought, won, lost, and succumbed to—fails to consider the sheer chance of it all. Sure there are cancers that we bring upon ourselves, but most are a result of the tiniest bits of bodies going rogue for reasons we’ve yet to understand. To speak of lost battles as though the warrior didn’t want victory badly enough projects our proclivity to control outcomes onto something that cannot be controlled.

In the same vein, I recommend these two pieces written after Canadian politician Jack Layton passed away by Carly Weeks and Edward Keenan. Both discuss the outpouring of support for Jack Layton that described him as “losing his fight against cancer” and the issues around those word choices. Similarly, other people have spoken up; some notable pieces include Beyond Breast Cancer, an open letter by Aria Jones and finally, an excellent piece by the late Julie Mason. There are a number of people who are against the current language choices we made, and I think they raise some very valid and very compelling points.

While some people may not like the metaphor, some might find strength and solace in it. For those, this language helps them, and if they want to consider themselves a warrior, all the power to them. That’s their decision and their prerogative. The Canadian Cancer Society sums it up well:

You may feel like a “survivor” or have heard the term used in conversation. But what does it mean? It means different things to different people. You may not like the way the word is used, or you might feel that it doesn’t apply to you. But the word “survivor” helps many people. It can be powerful, and for some, it’s a positive way of looking at themselves. Using it helps them to cope with their life after cancer.

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Atif completed his Masters and PhD in Epidemiology at Queen’s University, and currently works in health services research in Toronto, Canada as an epidemiologist. While his research examines the health of Canadians, he is also heavily involved in science outreach and communication. You can connect with him on Twitter @DrEpid

Think outside that box.
Cancer is not a disease.
It is not a foreign body or microbes that can be killed or neutralize. It is our own CELL that thrives to survive in a toxic internal environment of our body. It is the last and final attempt of our own CELL, in order to survive, develops into a CANCER CELL. The only way to combat immortal cancer cell is to Dedifferentiates into a normal cell and leaving the injury as scar.

We all struggle with the terms we use, and these terms can change at different stages. While I do not like the military/fighting metaphor, it sometimes was helpful in getting me to be more active even if I felt crummy. Similarly, with the survivor metaphor, while it is a strong metaphor for chemo, radiation and other therapy, it works less well for outcomes, given that some of us have curable cancers, some not.

I settled on living with cancer as it reflected my acceptance of my cancer, treatment, and ongoing side effects and fears of possible relapse.

That was the hope of this piece – I’d never want to take a term away that people find helpful. But we often use that language without thinking of the consequences, and that’s where I think we should be a little more careful. The word can be a source of solace and a source of frustration.

Thanks for this alternative perspective on dealing with cancer. My difficulty with the fighter/survivor metaphor in cancer is that it seems as though people are charged with an impossible task: one part of the self fighting another part of the self, like some psychotherapy. Throughout the media and through the medical written part of it particularly, cancer seems to be portrayed as a disease similar to those caused by microbes; as though people can kill off the infiltrating cells and become disease-free, usually through taking medicines. As you say, cancer is the misfortune of cell-growth gone wrong and we don’t seem to acknowledge that it is generated spontaneously inside each individual, not “caught” from other individuals. Sometimes cancer is spoken of as a “plague” but that just encourages us to think we can “fight it off” like the common cold. While nations devote vast sums to research aimed at finding drugs to suppress cancer cells and other huge sums to buying drugs from companies who hold the patents on them, we still also spend even more on treating and assisting people while we give them the drugs and operate on their vulnerable bodies. Who made the economic equation that spending megabucks on all aspects of cancer was “worth” more than boosting the public health basics like clean water, sufficient food, good hygiene and healthy habits, decent living allowances and peaceful conditions? Surely only the middle & upper classes benefit (and not all that much considering true cancer survivorship with good QoL) from cancer treatment just as they benefit from holding all the good jobs in research and manufacturing. Meanwhile workers and researchers with interests and investment in benefiting the “greater good” are short-changed, thus also short-changing the majority of the world’s population while politicians of all stripes back the minority and the privileged. It’s enough to turn some people into “communists”!

Thank you Atif for this. It’s not just military metaphors, however, and it’s not found just in oncology. We see this in chronic diagnoses like heart disease every day. Dr. Jack Coulehan, whom I quoted two weeks ago on this subject, sees three basic themes commonly used in medical metaphor: war (“She’s a fighter!”), engineering (“He’s in for a tune-up!”), and paternalism (“We don’t want him to lose hope!”)

He also observed that the relative demise of paternalism in medical metaphors (which at least somehow implied a human, caring interaction) has been “accompanied by the rapid advance of engineering and war metaphors, both of which tend to objectify and dehumanize the patient.”

I’d also recommend Barbara Ehrenreich’s excellent book “Bright-Sided” in which she describes her own experience as a breast cancer patient in which she addresses the impossible expectations that if she just fought hard enough or thought enough positive Lance Armstrong-like happy thoughts, she would “win” her “battle”.

Hi Lea and thanks for your comment. I imagine if I looked globally there would be similar examples in many countries – as a Canadian I read a lot following Jack Layton’s passing, but that example definitely hits many of the same themes as the Weeks and Keenan articles. Thanks for sharing that.

I emailed the NIH’s Extramural Nexus last week with a question about my scientific situation, and a few suggestions about how we should proceed toward “curing cancer”. I used “war language” since it’s the only thing funding agencies seem to respond to these days (although they still have not gotten back to me):

“If we as Americans are at “war” with cancer, perhaps the DOD should fund large science hubs and centers in a manner similar to the Manhattan Project. Now that would create jobs, and it would be nice to be curing people rather than killing them.”

Many of the USA scientists currently in control of the budgets grew up during the Cold War, so this language is fairly well ingrained in their minds.